Vascular and Interventional Radiology

Vascular and Interventional Radiology (VIR) is an innovative branch of medicine in which physicians treat diseases non-operatively through small catheters guided to the target by fluoroscopic and other imaging modalities. Many of these minimally invasive procedures have replaced traditional surgery.

The Division of Vascular and Interventional Radiology at Dartmouth-Hitchcock Medical Center offers a comprehensive program of diagnostic and therapeutic procedures to treat a variety of disorders. VIR maintains an excellent relationship with other clinical services, including nephrology, urology, gastroenterology, cardiology, oncology, vascular surgery and gynecology. These relationships have helped VIR build a vibrant clinical practice and stay on the forefront of new therapies, such as:

Uterine artery embolization for the treatment of symptomatic fibroids
Treatment of renovascular hypertension and ischemic nephropathy through renal artery stent placement
Hemodialysis access interventions
Therapy for varicose veins in the lower extremities using endovenous radiofrequency ablation
Interventional oncology for primary and metastatic disease, providing Yttrium-90 radioembolization, chemoembolization, radiofrequency ablation, percutaneous alcohol ablation, and tracheobronchial stent placement

We have enhanced the clinical aspects of the VIR practice by creating a dedicated VIR clinic, located with other DHMC physician clinics. Patients referred to VIR are evaluated, examined and scheduled for appropriate procedures by interventional radiologists. VIR now has an admitting service, which admits selected patients to DHMC after their procedures, usually overnight. Sharene Evans, a dedicated VIR nurse practitioner, joined the practice in 2003. She takes an active role in the management of inpatients and outpatient follow-up; she also performs many of the venous access procedures.

Research
Vascular and Interventional Radiology has been involved in various research projects that traverse the entire breadth of the subspecialty, through the study of original ideas and participation in many multi-institutional trials. Current or considered trials include the Coral study of revascularization versus medial therapy for renal hypertension, catheter directed thrombolysis versus anticoagulation for DVT, and an evaluation of RFA for liver neoplasm.

Faculty members contribute to peer-reviewed journals and have active research interests. Dr. Eric Hoffer has published on endograft repair of thoracic aortic injury and transcatheter embolization for hemorrhage associated with pelvic fracture. Dr. John Gemery's clinical research on 3D imaging of the male pelvis to examine sources of impotence in male bicyclists was presented in 2005 at a urology conference; his ongoing research involves the effects of aspirin on the inhibition of central venous catheter infection. Dr. Anne Silas recently published a comparative review of all gastrostomy placements by interventional radiologists and gastroenterologists, as well as papers on the utility of covered stents for revision of aging and failing synthetic hemodialysis grafts. Dr. Andrew Forauer recently published papers on the histology and development of catheter-related (fibrin) sheaths, the conformation of adjacent self-expanding stents, and stent-graft treatment of patients with acute bleeding from hepatic artery branches. Dr. Forauer's ongoing clinical research is in the areas of hemodialysis vascular access, central venous catheterization, trauma, and oncologic interventions. (See Radiology Faculty Publications for citations.)

Teaching
Teaching always has been an emphasis in the VIR Division, highlighted by comprehensive Residency and Fellowship Programs. The VIR staff recently revised the curriculum for resident training at DHMC. The VIR training experience has been a positive influence for Radiology residents; generally 25 percent of the residents decide to continue their careers as VIR Fellows.

VIR Team
During the last several years, three new faculty members have joined the division. Dr. Eric K. Hoffer, who assumed the Directorship in July 2005, most recently served as Section Chief of Vascular and Interventional Radiology at the University of Washington School of Medicine and Harborview Medical Center. Dr. Andrew R. Forauer joined the VIR Division in 2004. Prior to coming to DHMC, he served on the faculty of St. Louis University Health Sciences Center and the University of Michigan. Dr. Nancy McNulty, an interventional radiologist, joined Radiology's Veterans Affairs division in 2006, and spends one day per week at DHMC assisting the radiologists in VIR.

Directions
From the Rotunda/Information Desk in the main Mall, head North toward the inpatient towers. Just after the stairs and before the elevator, follow the signs to Reception 3W.

From the East Entrance or the patient parking garage, go to Level three East Mall and proceed past the Emergency Department. Reception 3W is the second reception area on the left.

Physicians (Radiologists)